Risk Factors of Unplanned Readmission after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis.

PURPOSE

With an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the related quality of management and healthcare costs. Unplanned readmission after ACDF affects both the quality of management and medical expenses. This meta-analysis was performed to evaluate the risk factors of unplanned readmission after ACDF to improve the quality of management and prevent increase in healthcare costs.

MATERIALS AND METHODS

We searched the databases of PubMed, EMBASE, Web of Science, and Cochrane Library to identify eligible studies using the searching terms, "readmission" and "ACDF." A total of 10 studies were included.

RESULTS

Among the demographic risk factors, older age [weighted mean difference (WMD), 3.93; 95% confidence interval (CI), 2.30-5.56; <0.001], male [odds ratio (OR), 1.23; 95% CI, 1.10-1.36; <0.001], and private insurance (OR, 0.34; 95% CI, 0.17-0.69; <0.001) were significantly associated with unplanned readmission. Among patient characteristics, hypertension (HTN) (OR, 2.14; 95% CI, 1.41-3.25; <0.001), diabetes mellitus (DM) (OR, 1.59; 95% CI, 1.20-2.11; =0.001), coronary artery disease (CAD) (OR, 2.87; 95% CI, 2.13-3.86; <0.001), American Society of Anesthesiologists (ASA) physical status grade >2 (OR, 2.13; 95% CI, 1.68-2.72; <0.001), and anxiety and depression (OR, 1.39; 95% CI, 1.29-1.51; <0.001) were significantly associated with unplanned readmission. Among the perioperative factors, pulmonary complications (OR, 22.52; 95% CI, 7.21-70.41; <0.001) was significantly associated with unplanned readmission.

CONCLUSION

Male, older age, HTN, DM, CAD, ASA grade >2, anxiety and depression, pulmonary complications were significantly associated with an increased occurrence of unplanned readmission after ACDF.